Protis分析软件在评价神经系统疾病患者鞘内IgG合成与血脑屏障功能损伤中的应用

The clinical application of Protis system in the evaluation of intrathecal IgG synthesis and blood-CSF barrier lesion in patients with neurological diseases

目的分析多发性硬化患者和其他神经系统疾病患者鞘内IgG合成及血脑屏障功能状态，以探讨Protis分析软件和传统脑脊髓液（CSF）IgG生成指数以及24hIgG合成率在评价神经系统疾病患者鞘内局部IgG合成与血脑屏障功能障碍中的应用价值。方法用BN-Ⅱ特定蛋白分析仪检测34例多发性硬化患者、80例其他神经系统疾病患者、20例CSF正常患者血和CSF中自蛋白（ALB）、IgG含量，并用CSF免疫固定电泳检测IgG寡克隆区带。用传统公式分析计算IgG生成指数和24hIgG合成率，并将数据输入Protis软件分析，得出鞘内IgG合成率（IgGIF）。结果多发性硬化组血脑屏障功能基本正常，白蛋白商值（QALB）为4．5×10^-3[（3．1～7．6）×10^-3]，且与CSF正常对照组差异无统计学意义（D=5．25，P〉0．05），多发性硬化组34例患者中有31例患者寡克隆区带检测阳性，阳性率为91．2％；鞘内IgGIF、IgG生成指数及24hIgG合成率为31．25％（11．65％～71．45％），0．93（0．80～1．04），24．25mg／24h（15．25～46．15mg／24h），均高于CSF正常对照组（D=175．5、112．5、103．4，P均〈0．05）；而多发性硬化组的鞘内IgGIF、IgG生成指数及24hIgG合成率与寡克隆区带检测阳性率的差异无统计学意义（P均〉0．05）。其他神经系统疾病组QALB为35．2×10^-3[（18．5—55．5）×10^-3]，显著高于CSF正常对照组（D=102．7，P〈0．05），80例患者寡克隆区带检测全部为阴性，IgG生成指数及24hIgG合成率结果分别为0．75（0．69～0．82）、44．29mg/24h（20．35～65．98mg／24h），均高于CSF正常对照组（D=85．6、98．5，P均〈0．05），其他神经系统疾病对照组鞘内IgGIF阳性率为0（0／80），IgG生成指数阳性率为40．0％（32／80），24hIgG合成率阳性率72．5％（58／80）。此外，IgG生成指数随血脑屏障功能损害程度的加深呈递增趋势（P〈0．05），同时其假阳性率也随血脑屏障功能损害程度的加深逐渐增加（P〈0．05）；24hIgG合成率结果也存在同样的变化趋势。在多发性硬化组鞘内IgGIF与IgG生成指数和24hIgG合成率均存在显著相关性（r=0．788、0．695，P均〈0．05）；在其他神经系统疾病患者中鞘内IgGIF与IgG生成指数和24hIgG合成率不存在相关性（r值均为0．000，P均〉0．05）。结论用Protis软件分析得出的鞘内IgGIF，可更准确地反映出患者鞘内IgG合成情况，Protis分析软件在神经系统疾病的实验室诊断中具有较好的应用价值。

Objective To analyze blood-CSF barrier and cerebrospinal intrathecal IgG synthesis in patients of multiple sclerosis, and explore the Protis software, IgG index and IgG synthesis rate in the and evaluation for cerebrospinal intrathecal IgG synthesis and blood-CSF barrier dysfunction. Methods 134 patients with neurological diseases were divided into threes groups, including multiple sclerosis group （34 cases）, disease control group（ 80 cases） and control group （20 cases）. IgG and ALB concentration of CSF and blood was detected by BN-Ⅱ. The oligoclonal IgG was detected by immunofixation electrophoresis. The relationship between Protis software results and IgG index or IgG synthesis rate was calculated and analyzed. Results The function of blood-brain barrier was almost normal in multiple sclerosis group, QALS was 4. 5 × 10^ -3 [ （ 3. 1-7. 6）× 10^ -3 ], there was no significance compared with control group （ D = 5.25,P 〉 0. 05 ）. there were 31 patients with oligaclonal bands in cerebrospinal fluids in multiple sclerosis group （34 patients） with the positive rate of 91.2%. In muhiple sclerosis group the intretheeal IgGIF, IgG index and IgG synthesis rate of 24 hours were 31.25% （ 11.65%-71.45 % ）, 0. 93% （ 0. 80%-1.04% ）, 24. 25 mg/24 h（ 15.25-46. 15 mg/24 h） ,the results were all higher than that in control group （D = 175.5, 112. 5,103.4,P 〈0. 05）. And in muhiple sclerosis group there was no significant difference among the intrethecal IgGIF, lgG index and IgG synthesis rate of 24 hours, the positive rate of oligaclonal bands （P 〉 0. 05）. In disease control group（80 patients） QALB was 35.2 × 10 ^-3 [ （18.5-55.5）× 10^ -3 ] ,the result was significantly higher than control group （D = 102. 7 ,P 〈0. 05 ） , the oligaelonal bands were all negative, IgG index and IgG synthesis rate of 24 hours were 0. 75 （0. 69-0. 82） ,44.29 mg/24 h （ 20. 35-65.98 mg/24 h） were both higher than control group（ D = 85.6,98.5 ,P 〈 0. 05）. In disease control group the positive rate of intrathecal IgGIF, IgG index and IgG synthesis rate of 24 hours were 0 （0/80） , 40. 0% （32/80） , 72. 5% （58/80） respectively. IgG index and its positive rate both increased alone with the lesion degree of blood- brain barrier increasing （ P 〈 0. 05 ）. And there was similar trend in the IgG synthesis rate of 24 hours. There were significant correlations among intrathecal IgGIF, IgG index and IgG synthesis rate of 24 hours in multiple sclerosis group （r = 0. 788, 0. 695 ,P 〈 0. 05 ）. However there was no correlation among intratheeal IgGIF, lgG index and lgG synthesis rate of 24 hours in disease control group （r =0. 000,P 〉0. 05）. Conclusions The Protis software can be used to analyze the intratbecal IgGIF and reflect the actual status of intrathecal IgG synthesis more accurately. Protis software has great application value for clinical diagnosis for nervous system disease.